Healthcare Provider Details

I. General information

NPI: 1891738183
Provider Name (Legal Business Name): PAUL M FISCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 GATEWAY BLVD GATEWAY BLVD
GROVETOWN GA
30813-3195
US

IV. Provider business mailing address

PO BOX 2510
EVANS GA
30809
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-1600
  • Fax: 706-922-1010
Mailing address:
  • Phone: 706-650-7799
  • Fax: 706-650-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025973
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: